Although the symptoms of desert can vary…
Celiac disease is an intestinal absorption problem…
What Should Be Done After a Celiac…
Avoiding consuming the proteins contained in wheat, that is, following a gluten-free diet, has become very popular in recent years. Although at first only celiac patients and those with a certain disease did not consume gluten, gluten-free diet began to be preferred frequently due to the emergence of the relationship between gluten with more diseases and relieving the symptoms of people’s digestive system problems due to gluten-free diet. During the gluten-free diet, nutrition must be carefully evaluated and all the nutrients that the body needs should be included in the diet. People who start a gluten-free diet should definitely provide themselves with variety. Otherwise, they cannot take the macro and micro nutrients we need to meet the body’s needs as intended. People who follow a gluten-free diet, especially due to a disorder originating from the intestines, may experience malabsorption, so they should have their blood values checked every 3-6 months, and their vitamin and mineral values should be checked.
Carbohydrate and Fiber Intake in a Gluten-Free Diet
Dietary fiber is one of the food components resistant to digestive enzymes and is found in grains, fruits and vegetables. It is recommended to take 20-35 grams of fiber daily. With adequate fiber intake, blood sugar is regulated, reducing the risk of diabetes, improving intestinal health and reducing the risk of heart diseases. With a gluten-free diet, the elimination of wheat and high-fiber cereals from the diet, as well as the decrease in bread consumption, reduces carbohydrate and fiber intake. For this reason, people who follow a gluten-free diet should increase their fiber intake by taking advantage of different food groups. In addition to using fruits, vegetables and legumes in nutrition, the diet can be enriched in terms of carbohydrates and fiber by adding gluten-free oatmeal, quinoa, amaranth and teff seeds to meals.
Protein Intake in a Gluten-Free Diet
In a healthy diet, approximately 15% of the energy should be provided from proteins. Since meat group, dairy products, legumes and eggs are not prohibited in gluten-free diet, there is no deficiency in protein intake. While preparing these products, it is sufficient that the materials do not come into contact with gluten-containing products and kitchen utensils in order to avoid contamination. When the proteins from cereals are evaluated, there is a compensated deficiency. Quinoa and amaranth contain higher protein than wheat protein.
Gluten Free Nutrition and Vitamins
People on a gluten-free diet may experience deficiencies of thiamine, riboflavin, niacin, folate, vitamins A, E and K. In the absence of cereals, which are frequently used in our country in a gluten-free diet and which are especially rich in vitamin E and vitamin B1 (thiamine), the person’s vitamin intake may decrease. The way to prevent this decrease is to provide diversity. Green leafy vegetables are especially rich in folic acid. It should be included in the diet frequently. Quinoa and amaranth have higher folic acid content than wheat. Oats, on the other hand, should be included in the diet as it is rich in vitamin E content. For thiamine intake, eggs and legumes should be included in the diet and nutrition should be examined. If there is insufficient intake and values, the vitamin treatment that your doctor will apply should be taken care of.
Gluten-Free Nutrition and Minerals
In order to prevent mineral deficiencies in a gluten-free diet, it is recommended to consume at least 5 portions of fruit and vegetables per day. Calcium, iron, magnesium and zinc intakes may be insufficient in people on a gluten-free diet. The reason for this deficiency may be that the person does not diversify his diet by restricting himself too much and these people start dieting with intestinal problems. Teff seed, which has high iron and calcium content, can be consumed instead of wheat and barley. Nuts can be included in the diet for calcium intake. If the person cannot include dairy products in his diet, he can consume almond milk, which has a high calcium content.
Celiac and Vitamin – Mineral Deficiencies:
Celiac disease affects nutrient absorption negatively by causing deterioration of villi structures in the small intestine, and it can also cause blood loss by causing ulceration in the intestine. After the diagnosis of celiac, gluten-free diet should be started. This will reduce celiac symptoms and improve nutrient absorption. In particular, iron, calcium, vitamin D and B12 deficiencies can be observed. Iron deficiency anemia is also frequently observed in celiac patients. Iron deficiency anemia can have effects such as extreme fatigue, weakness and sudden changes in mood. In celiac patients, an increase in iron stores is observed with the resolution of intestinal villi damage and compliance with a gluten-free diet. After the diagnosis, blood values should be checked and supplements should be started if your doctor recommends it. Nutrition is also very important at this point. Meat, chicken and eggs prepared as gluten-free should definitely be included in the diet. To increase absorption, green leafy vegetables or citrus fruits with high vitamin C content should be included. For example, spinach can be consumed with eggs for dinner and the meal can be enriched in terms of iron content. Or, iron absorption can be increased by having a salad with lots of green arugula, red pepper and parsley with a red meat meal. Vitamin D deficiency, which has important effects on bone health and immunity, is also very common in children with celiac disease. Calcium deficiency, which is thought to be affected by vitamin D deficiencies, is also encountered in celiac patients. Calcium intake must be evaluated. Since lactose intolerance can also be observed with celiac, celiac patients who cannot consume milk and dairy products can benefit from green leafy vegetables, dried fruits and nuts.
Dietitian Dilara Tuygan
Tunçer, E., Yabancı Ayhan, N. (2021). Çölyak Hastalığında Mikro Besin Ögesi Eksiklikleri Ve Beslenme Önerileri. BANÜ Sağlık Bilimleri ve Araştırmaları Dergisi. 3(1), 29-38.
Marti-Carvajal, A.J., Sola, I., Lathyris, D., Dayer, M. (2017). Homocysteine-lowering interventions for preventing cardiovascular events. The Cochrane Database of Systematic Reviews, 8(8).
Rybicka, I.(2018) The handbook of minerals on gluten-free diet. Nutrients. 10, 16-83.
Saturni, L., Ferretti, G., Bacchetti, T. (2010) The Gluten-Free Diet: Safety and Nutritional Quality Nutrients. 2, 16-34
Alas, Celiac! What will happen now?
The only cure for celiac disease is a gluten-free diet. Patients need to maintain strict gluten-free meals for life. People diagnosed with celiac disease as a result of clinical symptoms, serological tests, and small bowel histology should immediately start a gluten-free diet. He should stay away from the consumption of wheat, barley, rye and oat foods and beverages that should eliminate gluten from his life. Gluten-containing and iced tea such as white bread, whole wheat bread, bran bread and pasta, bulgur are not consumed in the gluten-free diet. It should be used with gluten-containing foods, which we call cross contamination, which do not contain gluten, but in this utility, attention should be paid to gluten contaminated contents.
Serological, hematological and biochemical tests (complete blood count, iron profiles, thyroid tests, calcium, magnesium, zinc, B12, folic acid and vitamin D) density and dietary compliance should be monitored. It is also important in follow-up in children.
Transglutaminase needs to be measured in a certain way to observe the effect of gluten-free treatment. If there are serological findings that do not improve at the end of a year, it should be considered that there is contamination in the diet. Serological tests are considered as a symptom of reaching normal levels, and it is known that the fastest serological tests in celiac disease reach their normal values in the 6th month and the slowest at the end of the 1st year.
A gluten-free diet should be followed very strictly. Very low amounts of gluten can cause clinical symptoms to persist. Celiac patients and their relatives should be well aware of the free, unfavorable foods that are included in the gluten-free diet and which should be controlled.
Dietician Armoni Yılmaz
Guide to Diagnosis, Treatment and Follow-up for Family Physicians in Celiac Disease, 2019
KULOĞLU, Z. (2014). Celiac disease. Turkish Journal of Pediatrics, 8 (2), 105-111.
Öztürk, Y. E., Uyar, G. Ö., Serin, Y., & Gürkan, Ö. E. (2018). Gluten-Free Diet Treatment in Celiac Disease: A Case Report. Journal of Nutrition and Diet, 46 (3), 320-324